How Families are Affected by Addiction

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How Families are Affected by Addiction

• Robert J. Ackerman, Ph.D.
• Community Healing Centers/SPADA-WMU
• Kalamazoo, MI
• October 14, 2009

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Un-Treated Chemically Dependent Family Assumptions

• its not that bad yet
• its their problem
• cant talk about it!
• the longer the substance abuse continues the
  more problems are blamed on the chemical
  dependency

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• nothing can change or improve as long as the
  substance abuse continues
• if only the substance abuser would stop,
  everything would be OK
• substance abuse stops, its over, cant talk
  about it!

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Four Basic AssumptionsFamily Systems Model on
Addiction(Steinglass, 1987)

• The family is a behavioral system in which
  addiction related behavior has become a central
  organizing principle
• The introduction of addiction skews the family
  toward short term stability at the expense of
  long term growth.
• The family gradually accommodates family life to
  the co-existent demands of addiction.
• The types of alterations that occur in
  regulatory behaviors profoundly influence the
  overall shape of family growth and development.

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Family Ritual AssessmentRituala customarily
repeated act or series of acts

• Independent Rituals
• Those rituals that are positively maintained by
  a family in spite of the addicts influence on
  the family.
• Addicted Rituals
• The replacement of positive rituals by negative
  ones in the presence of the addict.

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Family Ritual Assessment

• Co-dependent Rituals
• Learned negative rituals due to living with
  addiction that are practiced even without the
  presence of the addict.
• Recovering Rituals
• The re-emergence of independent rituals and or
  the development of healthy family rituals with or
  without the sobriety of the addict.

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ASSESSMENT OF FAMILY FUNCTIONINGBEAVERS SYSTEMS
MODEL

• Based on how well a family functions as a group
• Family structure doesnt matter, ie. single
  parent, etc..
• Emotional state of a family depends upon
  intimacy-power-control

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Family Functioning Levels

• Level 5 Families
• Severe Dysfunction
• most pain, chaos, no clear authority figure,
  members focus on side issues that are usually a
  problem, avoid real problems, 8 of American
  families
• Level 4 Families
• The Borderline Family
• more functional, but is run by a tyrant who
  insists on her or his way and tells, members to
  what to think, do, and feel, 24 of families

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Family Functioning Levels

• Level 3 Families
• Midrange Families
• members live by a series of internalized rules,
  actually the rules rule them, too much role
  performance behavior, guilt, intimidation., and
  manipulation is what keeps members in line, not
  their own wishes
• Level 2 Families
• Adequate Families
• rules are consistent, clear authority figures
  (parents), flexible

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Family Functioning Levels

• Level 1 Families
• Optimal Families
• same as above, but members feel a strong sense of
  belonging and acceptance
• Beavers W.R. (1982). Healthy, midrange and
  severely dysfunctional families. In F.
  Walsh(Ed.), Normal Family Processes (pp.45-66).
  New Guilford Press

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Why Survivors of Dysfunctional Families Are Not
All the Same

• 5. Gender implications and
• interpretations
• 6. Age and developmental factors
• 7. Cultural considerations
• 8. Off-setting contributing factors

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Why Survivors of Dysfunctional Families Are Not
All the Same

• 1. Degree of dysfunction and the
• parental role
• 2. Type or kind of dysfunctional
• parent/s
• 3. Different reactions to stress
• 4. Personality and perceptions

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Family Dimensions with Chemical Dependency

• PERCEIVED ISOLATION
• I guess at what is normal.
• I feel different from other people.
• I have difficulty with intimate
• relationships.

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• INCONSISTENCY
• I have difficulty following projects through to
  the end.
• I look for immediate as opposed to deferred
  gratification.
• I manage my time poorly and do not set my
  priorities in an way that works well for me.
• SELF-CONDEMNATION
• I judge myself without mercy.
• I have difficulty having fun.
• I take myself very seriously.
  
  

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• CONTROL NEEDS
• I overreact to changes over which I have no
  control.
• I am either super responsible or irresponsible.
• APPR0VAL NEEDS
• I constantly seek approval and affirmation.
• I am extremely loyal even in the face of evidence
  that
• the loyalty is undeserved.
• I lie when it would be just as easy to tell the
  truth.

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• RIGIDITY
• I lock myself into a course of action without
  serious
• consideration to alternate choices or
  consequences.
• I seek tension and crisis and then complain.
• I avoid conflict or aggravate it, but rarely deal
  with it.
• FEAR OF FAILURE
• I fear rejection and abandonment, yet I reject
  others.
• I fear failure, but down grade my successes.
• I fear criticism and judgment, yet I criticize
  others.
• Adult Children of Alcoholics The Effects of
  Background and Treatment on ACoA Symptoms R.
  Ackerman E. Gondolf, International Journal of
  the Addictions, 26(11), 1159-1172, 1991.

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Major Areas of Concern for Children of Addicted
Families

• Worrying about the health of the addicted
  parent.
• Being angry and upset by the unpredictability
  of the addicted parent and the lack of support
  from the non-addicted parent.
• Worrying about fights and arguments.

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• Being scared and upset by violence or the
  threats of violence.
• Being upset by a parents deviant behavior.
• Being disappointed by broken promises and
  feeling unloved.
• Feeling responsible for their parents
  drinking/drug taking.

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Unspoken Rules of Troubled Families

• 1. Be in control at all times.
• 2. Always be right, do the right thing.
• 3. If something doesnt happen as planned, blame
  someone or yourself
• 4. Deny feelings, especially the negative or
  vulnerable ones like anxiety, fear, loneliness,
  grief, rejection or need.

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Unspoken Rules of Troubled Families

• 5. Dont expect reliability or consistency in
• relationships.
• 6. Dont bring transactions or disagreements
• to completion or resolution
• 7. Dont talk openly or directly about
• shameful, abusive, or compulsive behaviors
• in the family

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Recovery Lag

• not all individuals/families are affected the
  same way
• not all parts of the individual/family will need
  intervention
• not all individuals/family will respond the same
  way to treatment
• not all personal or family issues/problems will
  recover at the same rate
• not all members of the family will need the same
  amount of support
• not all individuals/families will recover to the
  same degree

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Strength-Based Recovery

• Victim
• List the ways that you feel
• or believe that you have
• been victimized
• 1.
• 2.
• 3.
• 4.
• 5.
• 6.

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• Victim Missing
• List the ways that you feel As a result of being
• or believe that you have victimized what did
• been victimized you miss?
• 1. 1.
• 2. 2.
• 3. 3.
• 4. 4.
• 5. 5.
• 6. 6.

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• Victim Missing Change
• List the ways that you As a result of being How
  you would
• feel or believe that you victimized what like to
  be
• have been victimized did you miss?
• 1. 1. 1.
• 2. 2. 2.
• 3. 3. 3.
• 4. 4. 4.
• 5. 5. 5.
• 6. 6. 6.
• The most important element is Choice

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Identifying strengths needed for change

• Identify the behaviors/talents you used to cope
  with dysfunction.
• Identify the strengths you learned from
  surviving dysfunction.
• Which strengths can you use in other
  functional/dysfunctional situations?
• How did you learn self-care and what strengths
  can you use now to increase and maintain your
  physical, emotional and spiritual health?
• What are your cognitive (thinking) and emotional
  strengths today?

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Fundamental Strategic Goals for Strength-Based
Models

• Recognize and build on existing strengths in
  individuals, families, and communities.
• Build new strengths in individuals, families,
  and communities.
• Strengthen the larger social environments in
  which individuals, families, and communities are
  embedded.
• Engage individuals, families, and communities in
  a strengths-based process of designing,
  implementing, and evaluating interventions.

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Family Risk Factors

• FRF
• (Family Risk Factors)
• FPF FRF
• (Family Protective Factors) (Family Recovery
  Factors)
• DFR
• (Degree of Family Resiliency)

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Resiliency in the Family System

• The property of the family system that enables
  it to maintain its established patterns of
  functioning after being challenged by risk
  factors.
• The familys ability to recover quickly from a
  misfortune, trauma, or transitional event causing
  or calling for changes in the familys patterns
  of functioning.

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Central Concepts in Family Resilience(McCubbin,
et.al.)

• Family Vulnerabilitythe family systems
  susceptibility to deterioration and dysfunction
  in the face of risk factors
• Family Crisisthe family susceptibility to
  continued instability, disorganization and
  dysfunction

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Processes of Family Resiliency(McCubbin et.al.)

• Adjustmentwhich involves the influence of
  protective factors in facilitating the familys
  ability and efforts to maintain its integrity,
  functioning, and fulfill developmental tasks in
  the face of risk factors
• Adaptationwhich involves the function of
  recovery factors in promoting the familys
  ability to bounce back and adapt in family
  crisis situations.

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The Impact of Gender in the Addicted Family
DYSFUNCTIONAL MOTHERS DAUGHTERS
SONS Role Models Image
Conscious Relationships with
Relationships with Women
women Parenting skills Protect
and defend Identity
Trust Trust
Emotional Incest Trying to please Shame and fear
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• DYSFUNCTIONAL FATHERS
• DAUGHTERS SONS
• Relationships Role Models
• Role Confusion Not good enough
• Intimacy Under-Fathered
• Sense of self Lack of emotions
• Sexual Abuse Just Like Him
• Perfectionism

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Goals in Family Recovery

• To learn about the disease of addiction
• To learn necessary skills about living with
  addiction
• To learn how to support sober behavior
• To learn how to discourage excessive alcohol and
  drug use
• To learn how to communicate with the substance
  abuser and other family members in a positive
  manner

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• To learn that you have a right to recovery and
  to identify your own recovery needs
• To learn how to support treatment for the
  substance abuser
• To learn how to create or re-create a positive
  family environment
• To learn that recovery takes time and not all
  family members will have the same issues and that
  not all family members will recover at the same
  rate
• To learn to make decisions and responsible
  choices

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• To learn how to function socially in new ways
• To learn how to establish relationships with
  friends, family and others
• To learn how to follow a recovery plan